Exam 4 Flashcards
6 P’s of neurovascular assessment
pain
pallor
pulselessness
paresthesia
paralysis
poikilothermia
inability to maintain a core temperature
poikilothermia
acute pain is less than ____ months, but chronic is greater than ___ months
3
COLDSPA
characteristics
onset
location
duration
severity
pattern
associated/aggravating factors
class of medication to avoid with GI bleeds and renal disease
NSAIDs
specific NSAID to avoid with renal disease
acetaminophen (Tylenol)
Tylenol has a high risk for ______ and can cause serious _____ damage
overdose, liver
Tylenol overdose is treated with IV ____
NAC (N-acetylcysteine)
8 S/E to be aware of with opioids
constipation
respiratory depression
sedation
GI upset (N/V)
addiction
pruritis
hypotension
withdrawal
you should administer geriatric patients _____ doses of pain medications because they do not metabolize them as quickly
lower
2 risks/side effects associated with pain medication that elderly people are at greater risk for
falls
respiratory depression
most common MS complaint
back pain
7 nonpharmacological treatments for degenerative disc disease
hot/cold compress
weight loss/management
muscle stretching
exercise
lumbar support belt
alternate periods of rest and activity
_______ is infection of the bone
osteomyelitis
7 people who are at risk for osteomyelitis
immunocompromised
obesity
geriatric
chronic illness
post-op
long term steroid use
orthopedic surgery
organism that is most likely the source of osteomyelitis
staph (MRSA)
reduction of bone mass due to deterioration without ability to replace it
osteoporosis
in osteoporosis the bone becomes ________, ________, and _______
porous, brittle, fragile
accelerated bone loss within the first 5 years of osteoporosis is caused by lack of _________
estrogen
most common complication of elderly
osteoporosis
osteoporosis is usually asymptomatic until the first clinical manifestation occurs which is a _______
fracture
people with osteoporosis will suffer from ______ fractures
compression
physical signs of osteoporosis
changes in height
kyphosis
protruding abdomen
low vitamin ____ levels put you at risk for osteoporosis
D
category of people most at risk for osteoporosis
thin postmenopausal women
long term _____ use can lead to osteoporosis
steroid
______ ______ _______ drugs can put you at risk for osteoporosis
proton pump inhibitor
birth control that can put you at risk for osteoporosis
Depo-Provera
hypo__________ and ________ disease can put you at risk for osteoporosis
parathyroidism, cushings
osteopenia is low bone mineral ______
density
osteopenia is a precursor for ________
osteoporosis
most accurate diagnostic test for osteoporosis
DEXA scan
3 drug classes used to treat osteoporosis
biphosphonates
estrogen agonists antagonists
RANKL inhibitors
biphosphonates can be taken daily, weekly, monthly ____ or quarterly or annually ____
PO, IV
estrogen agonists antagonists example
Raloxifene (Evista)
estrogen agonists antagonists can be taken ____ daily
PO
RANKL inhibitor example
Denosumab (prolia)
RANKL inhibitors can be taken ____ every 6 month
SQ
2 supplements than prevent bone loss
vitamin D
calcium
vitamin ___ is needed to adsorb calcium
D
most important side effect of biphosphonates
GI problems
most common GI problem with biphosphonates
dyspepsia (reflux)
4 teaching points with bisphosphonates
empty stomach
sit up 30-40 mins after
NOT for bedbound pts.
encourage weigh bearing exercises
3 serum diagnostics that help diagnose bone conditions
calcium
vitamin D
ALP
2 physical signs of osteomalacia
bow legged
kyphosis
osteomalacia can be caused by decreased vitamin ___ and failed _____ absorption
D, calcium
4 causes of osteomalacia
hyperparathyroidism
GI issues
malnutrition
long term anticonvulsant use
3 additional treatments for osteomalacia
sunlight exposure
calcium-rich foods (milk)
walking devices
in osteomalacia, X-ray will show __________ of the bone
demineralization
in osteomalacia, the pt. will have low ______, but high _____
calcium, ALP
2 cranial nerves to assess in someone with Paget’s disease
4 and 8
3 nursing considerations for someone with Paget’s disease
risk for falls
pain management
hearing loss
malignant bone tumor
osteosarcoma
benign bone tumor
osteoma
osteomas cause bone _____ while osteosarcomas cause bone _______
formation, destruction
both types of bone tumors will cause pathological _______
fractures
5 s/s of osteosarcoma
constant or occasional pain
weight loss
malaise
fever
mobility issues
2 serum diagnostic tests that will be elevated with osteosarcoma
calcium
ALP
bone scans detect radioactive material and are specific to diagnosing ______ and _______
osteosarcoma and osteomyelitis
3 treatments for osteosarcoma
surgical removal
radiation
chemotherapy
injury to a joint that causes adjoining bones to longer touch each other
dislocation
minor or incomplete dislocation in which the joint surfaces are still touching, but are not in normal relation to each other
subluxation
dislocation and subluxation are both _______
emergencies!!!
condition that occurs when there is not blood supply to the bone
avascular necrosis
4 complications that can occur with untreated dislocation/subluxation
avascular necrosis
muscle strain
ligament and tendon sprain
nerve damage
arthritis caused by an autoimmune disease
rheumatoid
arthritis caused by trauma/wear and tear on the bones and joints
osteoarthritis
arthritis caused by an infection in the joint
septic arthritis
population more at risk for osteoarthritis
women over age of 50
osteoarthritis is usually ______ lateral unless it is in the knees
unilateral
serum diagnostic test used to diagnose osteoarthritis
rheumatoid factor
serum diagnostic test used to diagnose gout
uric acid
elevated uric acid can also cause ______ ______
kidney stones
radiologic test used to diagnose osteoarthritis
X-ray
x-ray is always done first to rule out _______ ______
avascular necrosis
a ______ is the injury to ligaments and tendons around a joint caused by hyperflexion or twisting of the joint
sprain
a _____ is an injury to muscles or ligaments caused by overuse or excessive stress on the muscle or ligament
strain
2 things that help you figure out what degree the sprain/strain is
ROM and pain level
used intermittent cold packs for the first ___ to ___ hours after a sprain or strain
24-72
3rd degree sprains/strains needs to be _________ to keep the joint from losing stability
immobilized
with a 3rd degree sprain/strain you must do a ______ to rule out avascular necrosis
x-ray
with sprain/strain, report decreased sensation, decreased motion, and increased pain to avoid ______ syndrome
compartment
5 most common complications with MS injuries and surgeries
DVT
infection
avascular necrosis
compartment syndrome
fat embolism
first complaint with avascular necrosis
pain
ages ___ to ___ are at risk for AVN
30-50
______ and _____ use are associated with AVN
steroid, alcohol
2 diseases associated with AVN
Gaucher
Caisson
2 procedures that are associated with AVN
chemotherapy
radiation
3 treatments for AVN
NSAIDs
traction
joint replacement
edema/bleeding that is caused by an increase in pressure in a compartment that results in tissue death and dysfunction
compartment syndrome
pain associated with compartment syndrome
pain not relieved with meds
most common patient at risk for compartment syndrome
patients with a cast
compartment syndrome is more common in athletes under the age of ____
30
compartment syndrome is more common in people who do _____ _____ exercising like running
repetitive impact
surgical intervention for compartment syndrome
fasciectomy
orthopedic trauma puts you at risk for a ______ _____
fat embolism
_____ ____ fractures put you most at risk for fat embolism
long bone
fat embolisms occur ___ to ____ hours after fracture
24-72
7 s/s of a fat embolism
SOB
tachycardia
rash
hypoxia
confusion
tachypnea
chest pain
medications given to prevent fat embolisms
blood thinner and corticosteroids
_____ _____ filters can be used to prevent a fat embolism
vena cava
2 allergies to assess for before CT scan with contrast
shellfish
iodine
levels to check before IV contrast dye is administered because it can cause further damage to this organ
BUN and creatine
3 uses for external fixators
- complicated fractures with soft tissue damage
- lengthen limbs
- nonunion fractures
external fixators can lead to _____
osteomyelitis
most ominous (obvious) sign of compartment syndrome
pulselessness
first sign of compartment syndrome
pain unrelieved with medication
plaster casting takes ___ to ___ hours to dry
24-72
avoid covering plaster cast while drying to avoid ____ injury
heat
handle wet plaster cast with ____ to avoid pressure areas
palms
patients with planta fasciitis may get _________ injections
corticosteroid
Buck’s traction is a ____ traction
skin
keep leg in _____ position when applying traction
neutral
3 things to monitor/assess with traction
wrinkling of bandage
skin breakdown
nerve status and circulation
patient getting AKA should be in ____ position
supine
do not _____ the limb after AKA because it can cause hip contractures
elevate
macular degeneration causes loss of _____ vision
central
glaucoma causes loss of ______ vision
peripheral
cataracts causes _____ of the lens
opacity
____ angle glaucoma has a gradual onset, angle appears normal, and ocular pressure may be increased
wide
_____ angle glaucoma has a rapid onset, increased ocular pressure, headache, loss of central vision, and pupils will be fixed and nonreactive
narrow
_____ angled glaucoma is an ocular emergency
narrow
glaucoma med that causes constriction of the pupil and increases the space between iris and lens
cholinergics
glaucoma meds that boost uveosclera outflow by dilating vessels
prostaglandin analogs
glaucoma meds that decreased aqueous humor production (3)
beta blockers
alpha-adrenergic agonists
carbonic anhydrase inhibitors
cholinergcs expire after __ months at room temp
2
avoid dimly lit areas with ______
cholinergics
prostaglandins can cause ____ of the iris
darkening
4 things beta-blockers are contraindicated in
COPD
asthma
heart blocks
bradycardia
3 s/e of alpha agonists
redness of eyes
dry mouth
dry nasal passages
avoid ____ allergies with carbonic anhydrase inhibitors and watch for _____ imbalances
sulfa, electrolyte
patients should wear eye _____ post op cataracts surgery
shield
medications given post-op with cataracts surgery
mild analgesic
antibiotics
anti-inflammatory/steroid
a ______ feeling is normal after cataract surgery
scratchy
5 abnormal symptoms after cataracts surgery
floaters
flashing lights
decrease in vision
pain
redness
5 s/s of retinal detachment
sudden floaters
flashes
blurred vision
reduced peripheral vision
curtain-like shadow over field of view
3 assessment findings of a patient with conjunctivitis
redness
discharge
crustiness
4 things the patient may report when they have conjunctivitis
foreign body sensation
itchiness
scratching/burning
photophobia (discomfort with bright light)
always wear gloves when touching a patient’s eye with ________
conjunctivitis
______ conjunctivitis is associated with a history of upper respiratory tract infection
viral
2 organisms that cause viral conjunctivitis
adenovirus
H. simplex
if you have conjunctivitis you should not go to school or work for __ to __ days
5-7
administer eyedrops for conjunctivitis in the ____ ____ of the eye
inner canther
2 side effects that can occur with someone who is having cerumen impaction irrigation
vertigo
dizziness
cerumen impaction irrigation can cause perforation of the ______ _____
tympanic membrane
both otitis media and externa are treated with ________
antibiotics
do not get ear wet for __ to __ days when getting treatment for otitis media
3-7
avoid exposure to ______ if you have otitis media
smoking
3 symptoms you should report when you have otitis media
ear pain (otalgia)
purulent drainage
conductive hearing loss
when administering ear drops, pull the pinna _____ and back in adults
up
when administering ear drops, pull the pinna _____ and back in children
down
acute and chronic otitis media can cause tympanic membrane _______
perforation
periodic condition of the inner ear affecting fluid balance as a result of head injury or trauma
vertigo
abnormality of inner ear fluid balance
Meniere’s disease
triad of symptoms that characterize Meniere’s disease
vertigo
tinnitus
hearing loss
4 medications for Meniere’s disease
antihistamines
tranquilizers
antiemetics
diuretics
antihistamine for Menieres disease
Antivert
tranquilizer taken for Meniere’s disease
valium
antiemetic for Meniere’s disease
phenegran
2 surgical treatments for Meniere’s disease
shunting of fluid
vestibular nerve sectioning
you should decrease _____ intake and increase _____ intake with Meniere’s disease
salt, water
4 things to avoid with Meniere’s disease
caffeine
alcohol
aspirin
MSG (monsodium glutamate)
race, age, and gender most as risk for CVA
African American males over 55
most common CVA
ischemic stroke (87%)
most fatal CVA
hemorrhagic (50%)
______ stroke results from vascular occlusion (blood clot) that blocks or narrows an artery leading to the brain
ischemic
_______ stroke occurs when a blood vessel in the brain ruptures or bleeds
hemorrhagic
imaging study that determines what kind of stroke it is
CT scan
imaging that allows you to see the vessels in the brain
MRI
two imaging studies that are necessary to diagnose a CVA
CT scan
MRI
diagnostic studies that are beneficial in diagnosing the cause of the CVA
carotid ultrasound
EKG
medication used to treat an emergent ischemic stroke
tPA
tPA helps restore ____ ____ to the brain region affected by the stroke
blood flow
tPA must be administered within ___ hours of symptom onset, but the goal is within __ hour of arrival
3, 1
tPA is administered via ___ and is _____ based
IV, weight
4 things required to know before administering tPA
BP
weight
past medical history
time and onset of stroke symptoms
if you patient is on warfarin you must check ____ levels before administering tPA
INR
complication that could happen with tPA
worse bleeding in the brain
you should monitor your patient in tPA every ____ minutes for the first 2 hours
15
if the patients INR is greater than ___ they cannot get tPA
1.7
if the patient had head trauma/injury less than __ months ago they cannot get tPA
3
if the patient has had a stroke less than ___ months ago they cannot get tPA
3
if your patient has had a GI bleed less than ___ months ago then they cannot get tPA
3
______ women cannot get tPA
pregnant
if your patient have ______ they cannot get tPA because it worsens it
hypotension
if you patient has _______ then they cannot get tPA
thrombocytopenia
if your patient has had major surgery in the past ____ days then they cannot get tPA
14
if your patient has a _____ ____ or a ___ they cannot get tPA
foley catheter, IVs
tPA can cause increased _____ ______
intracranial pressure
if your patient is on tPA and has increased ICP you can administer _______
Mannitol
Mannitol is a ______ _____ that draws water out of brain cells and pulls it into the blood stream
osmotic diuretic
elevated the HOB to ____ degrees if they are on tPA
30
2 medications given for a non-emergent stroke
anticoagulants
platelet inhibitors
5 complications of hemorrhagic stroke
rebleed
hematoma
hydrocephalus
hypoxia
vasospasm
to prevent vasospasm post hemorrhagic stroke you can control _____ _____
blood pressure
calcium channel blocker given to control BP in order to prevent a vasospasm post-hemorrhagic stroke
nimodipine (nymalize)
homeostatic mechanisms to avoid hypotension and hypertension to prevent vasospasms
triple H therapy
3 aspects of triple H therapy
fluid volume expander - hypervolemia
induced atrial hypertension
hemodilution
